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CASE #5
PATIENT PRESENTATION
http://www.youtube.com/watch?v=xLlL24shW
7E
PATIENT PRESENTATION
• SIGNALMENT: 4week old, intact female, DSH
• PRESENTING COMPLAINTS: kitten is depressed
and appears to be very thin, has blood-tinged
diarrhea, occasional vomiting
• Hx: client lives in an apartment complex and
found this kitten outside. She thinks she know the
owner, but the owner doesn’t seem to be taking
care of her.
PATIENT PRESENTATION
• PHYSICAL EXAM FINDINGS
– 103.9
– ~6% dehydrated
– Ataxic, unstable
• Infected neonate may develop cerebellar hypoplasia or
retinal defects
– Lethargic
– Fecal-soiled rear-end
DIAGNOSTICS
• CBC
– Moderate to severe panleukopenia
• Positive parvo snap test
• Antibody titers
• Virus isolation is difficult
TREATMENT
• Maintain hydration and electrolyte balance
• Force-feeding
• Broad-spectrum antibiotics
PREVENTION & CLIENT INFO
• Proper vaccination is required to prevent disease
• Like canine parvovirus, this virus can remain in
the environment for years.
• Infected cats should be isolated as all body
secretions contain the virus
• Cats who survive the infection will not get reinfected later in life. They acquire life-long
immunity.
CASE #6
PATIENT PRESENTATION
PATIENT PRESENATION
• SIGNALMENT: 3mth old, intact female, DSH
• PRESENTING COMPLAINT: kitten is sometimes
lethargic and seems to be bloated. She eats,
although appetite is decreased. Owner can still
feel and see the backbone and pelvic bones.
• Hx: owner is fostering a litter of kittens from a
shelter for the past 3 weeks, until they are
healthy enough for adoption. The kittens have
had intermittent diarrhea over the past 2 weeks,
but has resolved
PATIENT PRESENTATION
• Hx: The other 5 kittens are generally healthy
– Diet: dry kitten Iams
• PHYSICAL EXAM:
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Distended abdomen, although BCS:2/5
Depression
~6% dehydrated
Mm: pale pk, CRT:2sec
Temp: 102.9. HR: 200, RR: 30
DIAGNOSTIC TESTS
• FECAL
• ABDOMINAL RADIOGRAPHS
• CBC/SERUM CHEMISTRY
• ABDOMINOCENTESIS
• ANTIBODY TITERS(?)
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
DIAGNOSTIC TEST RESULTS
• FECAL(?)
• There is NO “FIP SPECIFIC” antibody titer test
• CBC/SERUM CHEMISTRY
– Low albumin/globulin ratio (<0.8) in the blood
• ABDOMINAL RADIOGRAPHS
– Ascites found
• ABDOMINOCENTESIS
– Viscous, clear to yellow fulid, high protein, low
cellularity
– RIVALTA TEST positive
• DIAGNOSIS: FELINE INFECTIOUS PERITONITIS
DIAGNOSTIC TESTS
RIVALTA TEST
•
Fill a clear test tube ¾ full
with distilled water, add one
drop 98% acetic acid and mix
(or vinegar).
• Carefully place one drop
Of the cat’s effusion on the
surface of the acid.
• If drop disappears
Test = negative
• If drop retains shape
Test = positive
DIAGNOSTICS
TRANSMISSION & PATHOPHYSIOLOGY
TRANSMISSION & PATHOPHYSIOLOGY
TRANSMISSION & PATHOPHYSIOLOGY
• FIP occurs in 2 forms: the “wet” or effusive form
(75%) and the non-effusive or “dry” form.
– DRY FORM
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Fever
Anorexia
Depression
Wt. loss
Ocular lesions – hyphema, iritis, retinal hemorrhage
Neurologic lesions
Rarely, enlarged kidneys
This form of the disease is vague and progresses slowly –
these animals may live months to years
DRY FORM
UVEITIS, RETINITIS, IRITIS
FIP: DRY FORM
MESENTERIC
LYMPHADENOPATHY
IRREGULARLY MARGINATED
KIDNEYS, POSSIBLE RENOMEGALY
TREATMENT & PREVENTION
• SUPPORTIVE CARE
– Thoracocentesis/abdominocentesis to make pet more
comfortable
– Daily steroids
– Antibiotics
• PREVENTION
– Control of the virus shedding is key
– House cats separately
– Clean litter boxes frequently
• The virus can last up to 4 weeks in the environment, but is killed
easily by disinfectants
– Lower number of cats
– Lower stress
– Vaccinate against feline coronavirus
CLIENT INFO & PROGNOSIS
• Clinical FIP is almost always a fatal disease
with a mortality rate >95%.
– Cats with the effusive form usually progress more
quickly and often die within 2 months of initial
diagnosis
CASE # 7
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: ~2-3yr old intact male DSH
• PRESENTING COMPLAINT: cat seems to have
lost weight in the last few months and seems
lethargic
• Hx: unknown, client feeds this stray cat who is
very friendly. She brings him in out of concern
for his health
PATIENT PRESENTATION
• PHYSICAL EXAM
– BCS: 2/5
– Temp:103.1, HR: 160, RR: 30
– Enlarged mandibular lymph nodes and popliteal
lymph nodes (see pic below)
– Firm, mid-abdominal mass palpated
Enlarged popliteal lymph node
Lbah.com
DIAGNOSTIC TESTS
• CBC/SERUM CHEMISTRIES
• ABDOMINAL RADIOGRAPHS
• FeLV/FIV Test
– All cats that go outdoors or come from unknown
backgrounds should be tested for FeLV and FIV
when first examined by a veterinarian
DIAGNOSTIC TESTS
TUMOR OF THE THYMUS – WOULD OCCUR IN
A YOUNG ANIMAL INFECTED
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
DIAGNOSTIC TESTS
• CBC
– Nonregenerative anemia
– Leukopenia – this virus can affect the bone marrow
resulting in feline panleukopenia-like syndrome
– These patients are at a higher risk for contracting
Hemobartonellosis (feline infectious anemia)
• FeLV ELISA
– positive
TRANSMISSION & PATHOPHYSIOLOGY
• Feline Leukemia is a retrovirus and is associated
with both neoplastic and nonneoplastic disease
• Lymphoma is the most common neoplastic
disease – tumors can occur in the thymus, GI
tract, or lymph nodes throughout the body
• Other clinical signs
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Secondary infections
Wt. loss
Anorexia
Neurologic signs
Spontaneous abortion
TRANSMISSION & PATHOPHYSIOLOGY
• TRANSMISSION:
– The most likely route of infection is through
continued intimate contact such as grooming,
sharing food and water bowls (virus shed in saliva,
urine, tears) – this is horizontal transmission
– The virus can also be transmitted to neonates in
utero and through the milk of infected queens –
this is vertical transmission
TRANSMISSION & PATHOPHYSIOLOGY
• POSSIBLE OUTCOMES OF FeLV INFECTION
– 1. Cat may mount an immune response, clear the
virus, and become resistant to future infection
– 2. some cats fail to mount an effective immune
response, become persistently viremic, and succumb
to FeLV-associated diseases
– 3. the virus is cleared from the plasma or serum but
persists in a latent form in the bone marrow or
lymphatic tissue.
• Outcome depends on:
– Age, immunocompetence, concurrent disease, viral
strain, dose, duration of exposure
TREATMENT
• NO CURE for FeLV
• IMMUNOMODULATING DRUGS
– Human interferon-α – interferes with viral replication
– Acemannan – from the aloe vera plant is known to
have antiviral, immunostimulant, and antineoplastic
properties
– Proprionibacterium acnes – killed form of this bacteria
can be given to stimulate the immune system to fight
disease
• ANTIVIRAL DRUGS -*can be toxic to bone marrow in cats
– AZT – antiretroviral
• ANTIBIOTICS
• POSSIBLE CHEMOTHERAPY
CLIENT INFO & PROGNOSIS
• FeLV positive cats should be retested 3-4
months after initial test
• FeLV cats should be isolated from all other
cats
• FeLV cats should be kept indoors
• FeLV cats should have reduced stress and
regular vaccination and veterinary check-ups
• Life expectancy is approximately 2 years after
diagnosis
CASE #8
PATIENT PRESENTATION
PATIENT PRESENTATION
• SIGNALMENT: ~4-5yr old, intact, male, DMH
• PRESENTING COMPLAINT: inappetant,
hypersalivation, lethargy
• Hx: indoor/outdoor cat, has not had
vaccinations in over 3 years. Cat has had a few
fights with other neighborhood cats over the
years, but nothing serious.
PATIENT PRESENTATION
• PHYSICAL EXAM:
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Gingivitis, stomatitis
Wt. loss
Temp: 103.5, HR: 200, RR:36
Mm: pale , CRT: 2sec
• Other clinical signs may include:
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Gingivitis, stomatitis
Chronic fever
Vomiting
Diarrhea
Chronic URI
cachexia
Chronic, unresponsive skin/ear infections
DIAGNOSTIC TESTS
• CBC/SERUM CHEMISTRIES
• FeLV/FIV ELISA
– All unvaccinated outdoor cats should be tested for
these diseases as they are contagious and without
cure
DIAGNOSTIC TEST RESULTS
• CBC
– Anemia, lymphopenia
• ELISA positive
– THIS IS AN ANTIBODY TEST, not antigen – there will be
interference by maternal antibodies and vaccination!
– Test result may be supported by other lab tests such
as IFA, Western blot, & PCR
TRANSMISSION
• TRANSMISSION
– Most infections are acquired through horizontal
transmission among adult male, sexually intact
cats
– Fight and bite wounds appear to be the major
route of transmission.
– It is possible to transmit the virus vertically to
neonatal kittens, but the virus is not easily
transmitted this way.
TREATMENT
• SEE FELINE LEUKEMIA VIRUS
• DENTAL SURGERY
– Whole mouth extraction of teeth may be
necessary in cats with chronic stomatitis and
gingivitis
CLIENT INFO & PROGNOSIS
• Although FIV is morphologically and
biochemically similar to HIV, it poses no threat to
humans
• Infected cats may survive for prolonged periods
before experiencing advanced stages of the
disease
– Some may be asymptomatic for 10+ yrs
• Keep FIV pos cats indoors
• Keep FIV pos cats free of stress and concurrent
disease